HomeMy WebLinkAboutBLD1825 Shed and Bathroom - BLD Application - 5/5/1975 BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
.7plicant to complete numbered spaces only.
PERMIT NO.��- � m
JOB ADDRESS
LEGAL �I '� ( SEE ATTACHED SHEET)
OWNER 9MAIL ADDRESS /' ZIP PHONE/
4/ j rr f
CONTRACTOR MAIL ADDRESS PHONE LICENSE NO.
3
ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
LENDER MAIL ADDRESS BRANCH
6
USE OF BUILDING
7 e cz e 2
8 Class of work: NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE
9 Describe work: / 1
U � li✓ v„ ��r 2 � ,b 77�/�c�
10 Change of use from
Change of use to
11 Valuation of work:$ ���! PLAN CHECK FEES PERMIT FEE J
SPECIAL CONDITIONS: Type of Occupancy
Const. kV I j.� r'jvay Group 0 7e, Division
Size of Bldg. No.of Max.
(Total)Sq. Ft. l5 U Stories 1 Occ. Load
Fire Use Fire Sprinklers yy��
APPLICATION ACCEPTED BY: PLANS CHECKED BY APPROVED FOR ISSUANCE BY: zone Zone Required ❑Yes .KNo
No.of OFFSTREET PARKING SPACES:
A/I
�Q,� z`y��_ Dwelling Units Covered Uncovered
N 0 T I C E ,Special Approvals Required Received Not Required
ZONING.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEALTH DEPT.
HEATING, VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT.
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- OTHER (Soecify)
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
I hereby certify that I have read and examined this application and
know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied with whether
specified herein or not. The granting of a permit does not presume to
give authority to violate or cancel the provisions of any other state or
local law regulating construction or the performance of construction.
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
SIGNATURE OF OWNER if OWNER BU R DATE)
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
y SHELTON PRINTING CO.
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• PLOT PLAN
ADDRESSI/ e i'p/�npBRMIT NO.
In D
LEGAL s °
DESCRIPTION LOT BLK ADDITION
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SITE AREA A/. ��' �` Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS /S � _Sq. Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.)
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN -rHE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION P"ID SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
i
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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A
f
SM'
4'
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without
first obtaining approval.
NAME(S) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) GNATURE OF OWNER(S) OR AUTHORIZED RES ENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED , N ' /,�. r L DATE/2
I
" MASON COUNTY PLANNING DEPARTMENT
P.0. Box 400 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT—Complete ALL items. Mark boxes where applicable.
LEGALDE8CRIPTION L1/IF
Location
✓/� /�V h
Of NS NS
Building -�I cI e-
E W side of feet E W from intersection of
Sect. Twp. Range
NO. PLUMBING FIXTURES FEE NO. GAS APPLIANCES FEE GAS PLUMBING
WATER CLOSETS S J EACH UNDER 60 MBTU SEWER SEPTIC TANK
BASINS EACH 60 TO 120 MBTU
BATH TUBS EACH 120 TO 200 MBTU
J� SHOWERS - ,`r6 EACH 200 TO 500 MBTU
WATER HEATERS- D EACH OVER 500 MBTU
AUTO. WASHERS
SINKS
FLOOR DRAINS
DRINKING FOUNTAINS �O
- s J
LAUNDRY TRAYS
Connect to City Sewer SERVICE CONNECTION
DISH WASHER
DISPOSAL
URINAL
Distribution System
By Special Permit
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR
GAS AND WATER. SKETCH IN SEPTIC TANK & DRAIN
pi FIELD LOCATION OR SUBMIT ON OTHER SKETCH.
PERMIT PERMIT
FIELD INSPECTION
Date By Remarks
Name /_— Mailing address — Number, street, city, and State Zip code Tel. No.
Owner 2�/' 4 G/PV �0 ,I'n� v /1 �2
Contractor
The owner of this building and the undersigned agree to conform to all applicable laws of.Mason County
Signature plicant Address Application date
7
DO NOT WRITE IN_THIS_SPACE _— FOR OFFICE USE
App ed by Permit fee Date permit issued Permit number Receipt No.
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